01-緒論+生長發(fā)育+兒童保健

Introduction曹勵(lì)之

Physicalandemotionalhealthofinfants、children、andadolescents；theirgrowthanddevelopment；theirdiseaseprevention;andtreatment.Development、Prevention、Clinicpediatrics

Perinatology(圍生醫(yī)學(xué))、Neonatology(新生兒學(xué))、Adolescentmedicine(青春期醫(yī)學(xué))

Principles:protectchildren’shealth,improvethelifequalityPediatrics(兒科學(xué))Threedifferences:individual,ageandsexGoodrecoveryabilityWeakselfprotectionCharacteristicsPediatricsisnottheminiatureofinternalmedicineDifferentdevelopmentregulationsindifferentagesDifferentnormaldataaboutphysiologyandbiochemistryindifferentagesImmunesystemisnotasperfectasadult’sBiggerwaterandnutritionrequirementDifferentpathologicalchangesbetweenadultandchildrenSinglechildpolicy(China)ChildrenClinicalManifestationandDiagnosisInfectiveDiseasesChildrenSevereCan’tbelimitedmultisysteminvolvementNeonateNotspecificLosingdefinitelocationDosebeingconnectedwithdifferentagesTreatingtheprimaryandthecomplicationsNursingandsupportingChangingquicklyGoodcapacityofrestoreLesssequelae(后遺癥)thanthatofadultexceptnervoussystemEmphasizeguardingofyounger,weaknessandcriticallyillTreatmentandPrognosisMonitoringofperinatalperiodPlannedimmunization

Fourofthemostordinarydisease(malnutrition,anemia,diarrheaandpneumonia)Preventingtheadultdisease(obesity,hypertension,diabetesorcoronaryheartdisease)Prevention

GOBIGrowth,Oralrehydration,Breastfeeding,ImmunizationIMCI(integratedmanagementofchildhoodillness)Pneumonia(19%)Diarrhea(18%)Malaria(8%)Measles(4%)HIV/AIDS(3%)Neonataldiseases(37%):preterm,asphyxia,infection

Principlesofchildren’shealthcareInfectiousdiseasesMentalproblemsinchildrenPreventionofadultdiseasesinchildrenAccidentalinjuryinchildrenEnvironmentalpollutionAdolescentmedicineandothersubjects’immersionintothePediatricsGeneticdiagnosisandpreventionofchildren’sdiseasesChallengesandfuturesFetalperiodFromfertilizationtothebirthofthebabyStagesofDevelopment(First)

StagesofDevelopment(Second)

Newbornperiod

Fromumbilicalcordligationto28thday(Earlynewbornperiodisyoungerthan7days)BadabilityofadjustingandadaptingHighmorbidityandmortality

Importanceofhealthprotection,nursingandplannedimmunizationPerinatalperiod:from28weeksofpregnancyto7thdayafterbirthPerinatal

mortality(死亡率)isanimportantguidelineofjudgingdevelopingdegreeofonecountry.CharacteristicMouthSkinApgarscoreMother/infantbinding(roomingin)RuleoutcongenitalgeneticandmetabolicdiseasesFunctionanalysisNurseatbirthImmunizationshouldbepostponedifthechildhasanacutefebrileillness.Prematurebabiescanbeimmunizedfollowingtherecommendedscheduleaccordingtochronologicalage,i.e.immunizationshouldnotbepostponed.ContraindicationsBeingtreatedwithchemotherapyorradiotherapyformalignantdiseaseOnimmunosuppressivetreatmentafterorganorbonemarrowtransplant.Onhigh-dosesystemicsteroids.Withimpairedcell-mediatedimmunity,e.g.severecombinedimmunodeficiencysyndromeorDiGeorgesyndrome.LivevaccinesarecontraindicatedinimmunocompromisedchildrenStagesofDevelopment(Third)

Infancyperiod

Afterdeliveryto1yearold

Characteristic

RapidestperiodofgrowthLargerrequirementofnutritionandenergyToomuch:obesity,diarrheaDeficiency:anemia,malnutrition

BreastmilkPlannedimmunization

Susceptivetotheinfectiousdiseaseinthelatter6monthsPhysicalexamination:age<6months:everymonthage>6months:every2-3monthsStagesofDevelopment(Fourth)Toddler’sageFrom1yearto3yearsCharacteristicFasterintelligencedevelopmentElementaryeducationPoorerabilityofidentifyingdangerThunderboltinjuryChangingoffoodMalnutrition,disordersofdigestionImmunedeficiencyBeingapttoinfectivediseasePhysicalexamination:every6months

StagesofDevelopment(Fifth)Preschoolage

From3yearsto6-7yearsCharacteristicSlower

growthMorematuredevelopmentofintelligence

plasticityculture(可塑性培養(yǎng))Trainingofgoodhabitandindependentability(sleeping,eating,stool,healthhabit)Preventionofinfectiousdiseasesandaccidents(learnselfprotection119,110,120)

Moreimmunedisease

StagesofDevelopment(Sixth)Schoolage

From6-7yearsto12-14yearsCharacteristic

Physicalgrowthbeingsimilarasadult’sExceptgenitalsystem

Comprehensivedevelopmentofthemorals,intelligenceandbodiesLowermorbidityCultivationofthesanitationhabitStagesofDevelopment(Seventh)

Adolescence

Girl：11-12y~17-18yBoy：13-14y~18-20yCharacteristicThesecondpeakofdevelopmentandgrowth.Thepeakdevelopmentofthegenitalsystem-healthcareTheinstabilityofneuroendocrinesystem-psychology;behavior;spiritScientificbreeding:newbornsandinfantsSuitablebreeding:laterstagesEarlyeducation:infantsandtoddlersInjuryprevention:toddlers,pre-schoolsandschoolagesPsychiatriceducation:pre-schools,schoolagesandpubertySexeducation:schoolagesandpubertyHealthCareGrowthandDevelopmentGrowth

MorphologicalgrowthoforgansandsystemsQuantitativechangeDevelopment

Differentiationandmaturefunctionofcells,organizationsandorgansQualitativechangeDefinitionContinuedprocessandsegmentalRulesUnbalancedevelopmentofsystemsandorgans抬頭（3m）Generalrules(First):Up→Down獨(dú)坐（6-8m）扶站（9-11m）獨(dú)走（13-15m）

獨(dú)坐持物（12月）翻身（6-7個(gè)月）Generalrules(Second):

Near→Far探身取物（6個(gè)月）Generalrules(Third):Careless→Careful

單手持物（9個(gè)月）Generalrules(Fourth):Easy→Complex

Generalrules(Fifth):Low→High-grade

IndividualDifference

InfluencingFactorsInheritanceSexNutritionDiseasePregnancyEnvironmentPhysiqueDevelopmentWeight

Totalweightofallorgans,systemsandliquidinbodyReflectingconditionsofgrowthandnutritionCalculatingthedoseofdrugandtransfusionWeightofbirth

Boy:3.3±0.4kg

Girl:3.2±0.4kgNormalweightloss

Weightlossduringthefirst10days(3to9percent)

Twopeaks

Frombirthto6months

~3m:700~800g/m

4~6m:500~600g/m7~12m:300~400g/mAdolescence

4~5kg/y×2~3y

AgesWeight(kg)Increasedweight（kg）

1～12yAges×2＋83m6±12m9±24m12±Birth33/(0~3月)13/(3~12月)233/(1~2歲)Growthonweight<6mW：Watbirth（Kg）+m×0.7（Kg）7~12mW：6（Kg）+m×0.25（Kg）2y~pre-puberty：age×2（Kg）+7(or8)（Kg）or3~12m：[age（m）+9]/2(Kg)1~6y：age（y）×2+8（Kg）7~12y：[age（y）×7-5]/2(Kg)W=weight;m=months;y=yearsEquilibriumStandingHeightLengthfromthetopofheadtothebottomoffoot<3y:Lyingonback(recumbentlength)Atbirth

：50cm1y：75cm2y：87cm2~12y：age×7+70cm(75)

TwoPeaksofHeightInfants

Thefirst3monthsIncreasing11~12cm

Adolescence

PeakheightvelocityPHA(生長高峰)TwotimesofchildperiodspeedLasting2-3yearsGirlsbeinghigherthanboysParsSuperiorandParsInferiorAtBirth

ParsSuperior(0.60)>

ParsInferior(0.40)(上部量)(下部量)12yearsold

ParsSuperior=ParsInferiorSittingHeightHeightfromthetopofheadtohucklebonetuber

Representingthedevelopmentofskullandspine

<3y:Crown-rumplengthwhenlyingonbackFingerDistanceDistancebetweentwomiddlefingerswhentwoarmslyingatlevelRepresentingthedevelopmentoflongboneoftheupperlimbsNormal:<height

Unusual:>height1~2cmHeadCircumferenceAtbirth：33~34cm1y：46cm(thefirst3m=later９m＝６cm)2y：48cm5y：50cm15y：54~58cmChestCircumferenceAtbirth

：32cm＜headcircumference1~2cm1y：＝HeadCircumference

＞１y：＞HeadCircumference

AgeCC（cm）comparingwithHC（cm）ChestcircumferenceAtbirth32<1～21y

46equal>1y

HC+（age-1）>（age-1）CC=chestcircumference,HC=headcircumferenceGrowthcurveofCCandHCcmUpperArmCircumference

＜５y:Reflectingchildren’snutritionconditions

＞13.5cm：Fine

12.5~13.5cm：Medium

＜12.5cm：Malnutrition

ProportionofBody

Proportionoftheheadandheight:infants(1/4)-----adults(1/8)WeightbyStature（體形勻稱）

Weight-For-Height（身高的體重）

ChestCircumference/Height（身高胸圍指數(shù)）

EMI/age（年齡的體塊指數(shù)）

Trunk-LegRation（身材勻稱)SittingHeight/StandingHeight.Atbirth:0.67→14years:0.53SpanandStandingHeight常用的統(tǒng)計(jì)學(xué)表示方法

+2SD-2SD均值離差法P3rd

P50thP97th百分位法界值點(diǎn)的選擇（cut-offpoint）（1）均值離差法：±2SD（2）百分位法：P3rd～

P97thX測(cè)量值的表示（1）表格（2）生長曲線

生長曲線評(píng)價(jià)結(jié)果表示均值離差法：百分位法：等級(jí)法三分法下（異常）

中上(異常）五分法下（異常）中下

中中上上（異常）p3rdp25th

p50thp75thp97th

-2SD-1SD

1SD2SDXGrowthandDevelopmentofSystemsClosingofbonesuturesandfontanellesAreaAtbirthClosedage1.5~2cm≦18m0.5cm1~2mPalpable3~4mBonegap

PosteriorFontanelleFrontalFontanelle

SpinaldevelopmentAgeActivityMusclesSpinalcurve3mLifthead頸后肌頸曲（頸部脊柱前凸）6mSit腰肌胸曲（胸部脊柱后凸）12mWalk下肢肌腰曲（腰部脊柱前凸）7~8m:PrimaryTeethappears2y:DeciduousTeeth=moon’sage–(4~6)Itisunusualifnoteethat1year.2.5y:CompletedThefirstmolarat6y，thesecondat12y，thethirdafter18y.Teeth

SensoryandPerceptual,BehavioralDevelopmentDevelopmentofBrainweight

Brainweightweight%Adultbrainweight%Birth350g10%~12%25%6m600~700g50%12m60%2~3y75%4~5y80%~90%Adult1500g2%~3%Developmentofbrainfunction：Getclosedtotheadult’slevel:3yrsoldObtainadult’sfullfunctions:8yrsoldCongenitalunconditionedreflex緊張性頸反射握持反射爬行反射踏步反射擁抱反射Summary

Developmentofmorphologyisearlierthanthefunctioninthecerebralcortex；

Lowerexcitementincerebralcortexandhigherinsubcorticalcenter；

Unconditionedreflex；

Incompletemyelinizationofnervefibers

SensoryandPerceptualDevelopment

Abilityof

obtaininginformationfromenvironmentthroughsensororgans

andisessentialtootherareas’development.Newborns

Thebestfocusdistanceis20cm.Eyesandheadsarecapableoffollowingthefocusedobjects.Distinctionofsizeandshapeisalsopossible.聽感知的發(fā)育皮膚感覺的發(fā)育SkinsensationSensePerceptionDevelopment

SenseofTaste（味覺）

Atbirth:Rathermatureoftaste4~5months:Keyperiodofdevelopment

SensePerceptionDevelopment

SenseofSmell（嗅覺）

Atbirth:Lookingfornippleswhensmellingmilk’staste3~4m:Differentiationodor

7~8m:Responsetosweet-smellSensePerceptionDevelopment

TactileSensation

（觸覺）

Newbornsareverysensitiveinmultipleareas2～3y

Distinctproperty5～6y

Distinctobjectsofdifferentsizeandweight

SenseofpainNewbornsarenotsensitivetothepainbecauseofincompletemyelinizationofnervefiberswhichwillbeimprovedafter2months.MotorDevelopment

Lifthead2m

Lifthead3m

Stable4m

Verystable,freelyrotationRollover1~2m側(cè)臥至仰臥4~5月仰臥至側(cè)臥6~8月仰臥至俯臥1~2mNewborn6~8mWalk、Run、Jump6月扶站9~12月扶物走1歲獨(dú)走幾步1.5~2歲跑2歲雙足跳3~4.5歲獨(dú)足跳

大運(yùn)動(dòng)發(fā)育

二抬liftshead十站standsalone

四翻rollsover周歲走walksalone

六坐sits二歲跑runswell

八爬creeps三歲獨(dú)足跳hopsFineMotorDevelopment三玩手playshands一歲亂畫scribbles五抓graspsobject二歲折紙foldspaper七換手passesobject三歲搭橋buildsbridge九月對(duì)指picksupwiththumb-indexfingerSpeechandLanguageDevelopment

ConditionsoflingualdevelopmentHearing

CNSPronouncingorgans

|||Acceptance

Understandingandexpression

pronunciationAdvancedconditions：Adequatelanguage

Environmentalirritation1~6m

Pronouncesinglesyllable7~11m

Pronouncerepeatedsyllables10~13m

Say:“mom”1~3y

Sayvocabularies,simplesentencesandsingshortsongs4~5y

Saycompoundsentencesandsingnurseryrhyme7~24m

lingualinterpret2~3y

lingualexpressionSuspiciousdelayed14m

problemswithsingleword24m

problemsofcombining2words30m

difficultiesofspeakingsimplesentencesScreeningstandard24m

Vocabulary<30

——Disability

Vocabulary<50

——Suspicious個(gè)人-社會(huì)能力的發(fā)育（Personal—SocialSkill）

personal—socialskill

二笑smileresponsively

六認(rèn)生shywithstrangers

九月做再見wavebye-bye

一歲示需要indicatewants

二歲做游戲playinteractivegames

三歲會(huì)穿衣putonT-shirtListstheworryingsignsatagesgivenAgeDevelopmentalsign6-8weeksAsymmetricalMoroExcessheadlagNovisualfixation/followingNostartleorquieteningtosoundNoresponsivesmiling8monthsPersistingprimitivereflexesNotweightbearingonlegsNotreachingoutfortoysNotfixingonsmallobjectsNotvocalizing10monthsUnabletositunsupported1yearShowingahandpreferenceNotrespondingtoownname18monthsNotwalkingNopincergripPersistenceofcasting3yearsInaccurateuseofaspoonNotspeakinginsentencesUnabletounderstandsimplecommandsUnabletousethetoiletaloneNotinteractingwithotherchildrenNeverReflexDevelopment(Ⅰ)Appearsatbirthandneverdisappears

Cornealreflex(角膜反射)

Conjunctivalreflex(結(jié)膜反射)Papillaryreflex(瞳孔反射)

Pharyngealreflex(吞咽反射)NeverReflexDevelopment(Ⅱ)Appearsatbirthbutdisappearsat3~4monthsRootingreflex（覓食反射）

Suckingreflex（吸吮反射）

Graspingreflex（握持反射）

Embracereflex（擁抱反射）NeverReflexDevelopment(Ⅲ)Notexistatbirthbutappearsgraduallyandbestableat1year

Abdominalreflex（腹壁反射）

Cremastericreflex（提睪反射）

Tendonjerk（腱反射）PathologicReflex<4monthsKernigsign(+)<2yearsBarbinskisign(+)TheSongofGrowthandDevelopment

一哭二笑三伊呀四月哈哈望媽媽五抓六坐握足玩七翻八爬九叫爸十站對(duì)指十二走看圖說話在十八兩歲能用勺吃飯喜怒分明命令發(fā)三歲學(xué)穿鞋和襪長成大娃別嬌他PsychologicaldevelopmentBeginningofthecognitionprocessAlternativereactionstoenvironmentandstimulationUnconsciousattentionConsciousattentionThestabilityoftheattentionAttention

Nerveactionprocessthatdepositingand“readingout”theinformationFeelingmemoryTemporarymemory

repeatedrecognition

repeated

reproduce

MechanicalmemoryConsciousmemoryLogicalmemoryMemoryLong